FALL SPORTS 2025 REGISTRATION
INTERVAL HEALTH HISTORY FORM IS TO BE FILLED OUT AND SIGNED BY A PARENT/GUARDIAN AND RETURNED THE HIGH SCHOOL NURSE no earlier than the dates listed below:
  • VARSITY and JV SPORTS BEGIN AUGUST 18: INTERVAL HEALTH HISTORY FORMS ARE AVAILABLE ONLINE OR MAY BE PICKED UP IN THE MAIN OFFICE OR CAFETERIA BY ATHLETES.  COMPLETED FORMS NEED TO BE ATTACHED TO AN EMAIL  AND/OR RETURNED TO THE NURSE (MS. SENUS), NO EARLIER THAN JULY 21. *See more information below. 
  • ALL MODIFIED SPORTS CAN RETURN INTERVAL HEALTH FORMS NO EARLIER THAN JULY 21
Email *
STUDENT NAME (Last Name, First Name) *
PARENT PHONE NUMBER  (include area code) *
GRADE (Entering in the Fall) *
HEALTH EXAM INFORMATION
Please verify with parent or guardian the date of your last physical exam. If this date does not match the school's records, you will be notified by the Health Clinic.  Required NYS School Health examination form is the only form accepted for sports participation per NYSED. Forms are valid for 1 year to include the full month of the date of the examination. Forms are available online under athletics, in the main office and a link is  provided for your convenience to print and submit to your primary health care provider as needed if you are instructed to complete.
Required NYS School Health Examination Form (ONLY needed if not currently on file.)
Date of last NYS Physical Examination (Student/Parent Reported) (Enter in mm/dd/yyyy format). If unknown, enter 07/01/2024. *
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DD
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**I acknowledge that I will require an approved  30-day Interval Health History to be  completed by my parent/guardian prior to participating in selected sport. 

**I acknowledge that my parent and I have received and read the NYS Education Department Dominic Murray Sudden Cardiac Arrest Act....Please read document below....

Dominic Murray Sudden Cardiac Arrest Information

**I acknowledge that my parent and I have received and read the Concussion information and protocols/management. See school website for most up to date Concussion policy and the additional informational link below. 


 *
Required
SUBMITTING YOUR 30 DAY HEALTH INTERVAL FORM
Parental completed IHH forms should be returned to the clinic no earlier than 30 days prior to the starting date of the sport and no later than the date listed at the top of the sign up form. * IHH forms are required for all athlete's whose physical exam was  prior to July 21, 2025.  Forms are available online under athletics, in the main office and a link is  provided here for your convenience to print and submit. If submitting online, the form must be saved and then attached to an email sent directly to bsenus@northcollinscsd.org.

SPORT *
A copy of your responses will be emailed to .
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